The ability to render high quality health care in a cost effective manner is an elusive objective that many health care plans and providers have attempted but very few have actually attained. In this regard, despite substantial effort by health care plans, health maintenance organizations (HMO), physician networks, government-sponsored health care plans and the like, to provide even minimal standards of care, an in particular essential preventative care, such as immunizations and ongoing care for the treatment of chronic diseases, such as diabetes, virtually every attempt made in the art thus far has failed due to gross inefficiencies in the utilization of resources to provide such minimal levels of health care. As a consequence, such plans and programs fail to render all necessary care to the patients sought to be treated, thus resulting a system whereby substandard care is provided and/or patients do not receive necessary preventative care or treatment.
In an attempt to quantify the degree of quality of health care provided by a given health care providing entity, and in particular managed health care plans, numerous quality assurance measures have been implemented that seek to identify the level of care being provided, as well as how such care compares amongst competing health care providers, health care plans, and the like. In this regard, there is an extreme interest amongst consumers and public interest groups in assessing the degree of care administered to patients enrolled in a particular health care plan, particularly with respect to the access patients have to health care providers, the quality of care delivered to such patients, and overall patient satisfaction. Typically, such data is gathered via on-going surveys of patients and their experiences in receiving care from a particular health plan, as well as other statistical data related to the number and types of procedures offered and administered by a particular health care plan, particularly with respect to preventative care and chronic disease management.
While a substantial number of such health care quality assessment programs are administered on a nation wide, state, and local regional levels, the most well-known and widely utilized resource for comparing the performance of health care plans is that generated from the Health Plan Employer Data and Information Set (HEDIS®) survey administered by the National Committee for Quality Assurance (NCQA). In this regard, the NCQA sets standards for the quality of health care and service that health care plans provide to their members and, to the extent a health plan meets certain standards, such plan receives accreditation by NCQA. To that end, NCQA utilizes HEDIS as a set of standardized performance measures designed to evaluate the performance of managed health care plans, with particular emphasis on customer (patient) service, access to care and claims processing. Such survey data is further designed to provide comprehensive data related to a given health care plan's effectiveness to provide preventative care, such as immunizations, as well as delivery of quality care to individuals with chronic illnesses, such as diabetes and cardiovascular disease. Presently, the NCQA's HEDIS database features performance data and member satisfaction information from 267 health plans covering more than 61 million Americans.
Notwithstanding the data available to consumers, as well as any accreditation and/or certification that a given health care plan does provide a requisite level of quality health care, there is still lacking in the art any systematic and uniform manner by which such quality health care can be continuously and systematically delivered. Ironically, although the standards and criteria for providing optimal health care are apparently well-known, particularly with respect to specific types of preventative care and chronic disease management, no single health plan has been able to continuously provide such high quality of care. Lacking even further is any type of systematic approach that can be readily implemented by a given health care plan, HMO, and the like that is operative to not only substantially eliminate inefficient and ineffective health care practices, but consistently achieve an extremely high quality of health care conforming to standardized treatment protocols, particularly with respect to the administration of preventative care and treatment of chronic diseases. There is further a need in the art for such a system that can provide such high quality of health care that is further operative to serve as a profitable business model from which other health care plans and the like can readily emulate such that the high quality delivery of standardized health care, as can be objectively evaluated, can be immediately implemented.